Introduction to Is it legal to sterilize addicts?

Economists can roughly calculate dollar amounts for most things; child abuse is no exception. A report from the Pew Charitable Trusts concluded that in 2007, child abuse had a negative economic impact of just under $104 billion in the U.S. [source: Pew]. All of the medical costs expended for hospital visits, costs for foster care programs and for law enforcement salaries on answered child abuse calls, along with indirect costs like funding the court system and loss of productivity totaled more than the U.S. spent on education as a whole the year before [source: Heritage Foundation].

Of those cases of child abuse that plague the U.S., as much as 86.6 percent stem from neglect, where children are left to fend for themselves and aren't protected from imminent harm by their parents or caregivers [source: Kari and Associates, HHS]. A survey of child welfare professionals found that almost 80 percent of the workers estimated that at least half of all neglect cases arise from drug-addicted parents. It's also a vicious cycle: Children born addicted to drugs are two to three times more likely to be abused than non-addicted children [source: NACOA].

Considering the prevalence of child abuse in the U.S. and the disproportionate role that drug addiction plays in cases of abuse, it's little surprise that Barbara Harris created Project Prevention. Harris is the founder of Children Requiring a Caring Community (CRACK), the non-profit organization that carries out Project Prevention. In the late 1990s, the group began advertising its unconventional services via billboards and flyers distributed in poverty-stricken areas in Los Angeles. Taglines included, "Don't let pregnancy ruin your drug habit," [source: Paltrow].

The offer is simple. CRACK would pay current and former addicts $200 (and later $300) in return for undergoing sterilization surgeries like tubal ligation for women and vasectomies for men. For a lesser amount, addicts could agree to take long-term birth control. Addicts who refer others for sterilization get $50. Aside from signing a contract, there are no strings attached and payment is made in cash.

Within 13 years of its founding, CRACK paid $200 to $300 to more than 3,700 drug addicts in the U.S., is making inroads into the United Kingdom and has plans for a similar program in Kenya for women with HIV/AIDS [source: Time, Newman]. Yet wherever Harris or CRACK appears, controversy follows and some wonder whether the program is legal.

Project Prevention: Eugenics and Social Engineering?

In the early 20th century, the eugenics movement took root in the U.S. Eugenics is the concept of that a "fitter" human species can be created by removing those with undesirable traits -- like congenital or chronic diseases or low socioeconomic status -- from the gene pool. For several decades, eugenics enjoyed popular support. In fact, from the 1910s to the 1970s, federal and state governments carried out the sterilization of more than 60,000 Americans who suffered from epilepsy, mental illness, blindness or homelessness. The number also included healthy people of color [source: Lombardo].

Some allege that CRACK is simply the newest incarnation of this type of social engineering.

"It's simply a bribe for sterilization," said one Planned Parenthood director in 1999 [source: Belluck]. Indeed, that organization is one of numerous voices that allege Project Prevention's goals are immoral, unethical and possibly illegal -- at least as far as contract law goes.

Legally, the issue is whether a drug-addicted person is legitimately of sound mind and hence in a capacity to make the life-altering decision of sterilization. What's more, the concept of informed consent -- a custom associated with sterilization requires that the patient choose the procedure freely. Critics of Project Prevention argue the $300 cash given to the addicts is decidedly coercive [source: Scully].

The group is also often criticized as unethical for what appears to be a racial bias in Project Prevention. CRACK points out that under 1,000 of their clients have been black, whereas more than 1,800 have been white. However, critics point out that whites make up 79 percent of the U.S. population, while blacks account for just about 13 percent [source: U.S. Census Bureau, Newman]. In terms of hard numbers, the program appears equitably distributed by race, but is skewed disproportionately toward blacks.

Beyond race, the very design of the program is classist by nature. One critic describes CRACK as "a structure in which the economically privileged can and do dictate who will and who won't have children" [source: Scully]. Those in the drug treatment field criticize the narrow focus of the program; addicts aren't offered parenting or drug counseling, only sterilization. What's more, as critics point out, they're likely to use the money to simply buy more drugs.

For her part, Barbara Harris says she doesn't understand the controversy her program generates. She is the adopted mother of four children born to addicted parents. The people eligible to participate in her program have already borne at least one child already. And, ultimately, the decision to be sterilized has been left up to the addicts by the courts.

Otis, Ginger Adams. "Why I took $300 to be sterilized." New York Post. October 31, 2010. http://www.nypost.com/p/news/national/why_took_to_be_sterilized_doN9PJ7V9a8LX2jPomcgqO

Paltrow, Lynn M. "Why Caring Communities must oppose CRACK/Project Prevention: How CRACK promotes dangerous propaganda and undermines the health and well being of children and families." Journal of Law and Society. November 2004. http://www.advocatesforpregnantwomen.org/issues/oppose_crack.pdf